Clinical reference

Paediatric Obstructive Sleep Apnoea Referral

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012 · Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt)

Verified against3 documents

AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012
No dose - referral pathway, no medicine given in primary care
Pediatric Obstructive Sleep Apnea - StatPearls - NCBI Bookshelf - disease-level clinical article (paediatric-obstructive-sleep-apnoea-referral-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

Carers describe snoring, breathing through the mouth, and pauses in breathing they have watched happen [apnoea · mouth breathing · snoring]
Waking repeatedly at night, and bedwetting that has come back after a dry spell
Unlike adults, the standout feature in a child is altered behaviour
Broken sleep shows itself as overactivity, short temper or aggression, which is often what brings the family in
Odd sleeping postures and bedclothes thrown about suggest heavy movement overnight
Struggling academically is an accepted feature of sleep-disordered breathing at this age
Families often say nothing about sleep unless directly asked

Signs — what you find (7)

The child looks either worn out or, the other way round, wound up [fatigue]
Dark rings under the eyes and a boggy, swollen nasal lining
Small lower jaw, large tongue and a high vaulted palate
Adenoid facies with enlarged tonsils
Speech sounds blocked, and the nose is obstructed
Check muscle tone neurologically, and examine the heart for pulmonary hypertension [hypertension]
Weigh and measure at every visit: each 1 kg/m2 of BMI beyond the 50th centile adds roughly 12% to the risk

Tests (11)

Guidance is to ask how much and how well the child sleeps, and whether they snore, at each routine check
Screen repeatedly in neuromuscular disease, Down syndrome and craniofacial malformation
As many as 9.4% of school-age children born preterm are later found to have the condition
Refer a preterm child for a sleep study readily, since the classic picture is often absent
Teen STOP-BANG runs to 8 yes-or-no items: 0-2 is low risk, 3-4 intermediate, 5-8 high
An overnight sleep study is the definitive test once history and examination raise the suspicion
An apnoea-hypopnoea index of 1 or more counts as abnormal up to age 13, although a value of 1 to 1.9 per hour is still argued over
Home oximetry overnight supports the picture but cannot confirm the diagnosis
Home sleep testing is accepted for straightforward adult disease, but the AASM judges the evidence too thin in children
Chest film and ECG where an underlying heart or lung disorder is suspected
Echocardiography matters particularly ahead of surgery in a child with severe disease

If not this — what else fits (6)

Allergic rhinitis blocking the nose
Attention deficit hyperactivity disorder
Developmental delay
Night-time gastro-oesophageal reflux
Parasomnias, commoner here but not specific
Narcolepsy in an older child who is sleepy by day

SourceStatPearls "Pediatric Obstructive Sleep Apnea" - disease-level clinical article

Presentation findings are traced to the source above.

MOMETASONE FUROATE

1st line

Strength0.05 mg

Formnasal

Adult dose and duration

Not applicable - pediatric condition x 6-12 weeks trial

Paediatric dose

(Children >=2 years: 50 mcg (1 spray) into each nostril once daily in the morning for 6-12 weeks)

Dose by age
2 years and over:	50 mcg (1 spray) into each nostril once daily in the morning for 6-12 weeks

Dose source

AAP Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome 2012

Why

Intranasal corticosteroid trial reduces adenoid tissue size and mild OSA severity in children pending ENT referral

Cautions

SPECIALIST ENT REFERRAL MANDATORY: Definitive treatment for pediatric OSA with adenotonsillar hypertrophy is adenotonsillectomy.
Intranasal steroids are suitable for mild OSA or while awaiting surgical evaluation.
Direct spray away from nasal septum to avoid epistaxis.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
SNIFFACAN 50MCG/G NASAL SPRAY 15 ML	SIGMA TEC	25.20 EGP
TABUNEX 50MCG/G NASAL SPRAY 120 DOSES	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > AL ANSAR FOR MARKETING	28.80 EGP
NORHINOSE 50MCG/DOSE NASAL SPRAY 120 DOSES	EUROPEAN EGYPTIAN PHARM. IND. > AMRIYA	90.00 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - AHI greater than 9 events per hour (or mild-to-moderate disease with significant symptoms) is the threshold that warrants referral for adenotonsillectomy rather than continued medical trial.
RED FLAG - Complex comorbidities (obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders) may require positive airway pressure therapy or, in severe cases, tracheotomy - a different pathway from a nasal-steroid trial.
Oral or systemic steroids have no role in paediatric obstructive sleep apnoea; only the intranasal route has evidence of benefit.
Montelukast carries a risk of serious neuropsychiatric adverse effects including suicidal ideation, depression, anxiety, agitation and hallucinations.
Examine the cardiovascular system for signs of pulmonary hypertension, and assess muscle tone, in any child being worked up for obstructive sleep apnoea.
The increased work of breathing can cause failure to thrive, particularly in younger children.
Children born prematurely may not show the classic features, so refer for a sleep study at a low threshold.
Assess sleep quality and duration in every child being evaluated for ADHD before any medication is started.
Secondary nocturnal enuresis in a child is itself a reason to evaluate for obstructive sleep apnoea.
Children with Down syndrome or craniofacial abnormalities need post-operative surveillance and a repeat sleep study at least yearly, because the apnoea often persists or recurs after surgery.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.